clinical studies
Postepisiotomy Pain: Warm Versus Cold Sitz Bath

https://doi.org/10.1111/j.1552-6909.1989.tb00493.xGet rights and content

A repeated measure experimental design (N = 20) was used to assess the effectiveness of a warm versus cold sitz bath in relieving postepisiotomy pain. Sensation, distress, edema, and hematoma ratings were obtained pre- and posttreatments. Both therapies were found comparable, with the exception that the cold bath was significantly more effective in reducing edema. Recommendations for further clinical research are presented. The recommendation for practice is that patients be offered a choice of therapies.

Section snippets

Purpose

The purpose of this study was to investigate the effectiveness of warm versus cold sitz baths on postepisiotomy perineal pain. Specifically, an exploratory study was conducted with 20 postpartum subjects to assess the effects of warm and cold sitz baths following an episiotomy on self-reported distress and sensation, as well as ratings of edema and hematoma. The heuristic intent of the study was to provide empirical data that health-care providers could use in selecting pain-reducing modalities

Hypothesis

Based on the physiologic responses associated with cold therapy, the researchers hypothesized that postepisiotomy subjects will report greater decreases in selfreported sensation and distress ratings and will have less edema following cold therapy than they will following heat therapy in the early postpartum period, i.e., within 36 hours after delivery.

Subjects

Subjects were solicited from a population of women undergoing vaginal delivery with episiotomy at a midwestern university medical center. Selection of subjects was not random. All patients who 1) were fluent in English; 2) had episiotomy during delivery; 3) received only a local anesthetic; 4) reported at least some degree of perineal pain; 5) had no known mental disorder; and 6) had no history of preeclampsia, immunologic disorders, or cold allergy; and 7) consented to participate were

Results

Before analyzing data for treatment effects, ratings of sensation, distress, edema, and hematoma formation were tested for normalcy using the Shapiro-Wilk W statistic. None were found to be normally distributed. Hence, the planned nonparametric procedures were used for all subsequent data analyses.

For patients with more extensive perineal edema, cold sitz baths should be considered as the treatment of choice.

Pretreatment measures were analyzed to determine if pretreatment differences existed.

Discussions

Group comparability was evaluated, and the analysis failed to demonstrate any difference between the two groups on any of the measures. Therefore, subject variability may not account for lack of statistical support for the stated hypothesis. Analysis of order effect also failed to demonstrate a difference between the two groups, indicating that any differences were treatment effects and not order effects.

The outcomes of the study are limited because of small sample size, lack of control of type

Nursing Implications

Since both warm and cold sitz baths are comparable with respect to hematoma, sensation, and distress, and cold sitz baths are more effective in decreasing edema, both modalities should be considered as treatments for the postpartum patient. Some patients prefer the cold treatment, so perhaps the patient should be given the choice of either therapy when minimal or no perineal edema is present. Those patients who have a greater degree of perineal edema probably should be managed with cold sitz

Limitations

No attempt has been made to suggest an alteration in current practice. The small sample size, the lack of control of the type of episiotomy, and the current protocol of applying an ice pack to the episiotomy during the recovery period all limit the findings.

Conclusion

Since the dictum of “do no harm” will be honored, practitioners might consider the application of cold as a viable alternative. Certainly as noted earlier, further systematic investigations are needed to clarify the conditions under which these therapies are more or less effective.

Do You Want to be an Author?

If you’re thinking about writing an article for JOGNN, write for author guidelines. Submission requirement include

  • Papers must have no more than 25 references.

  • Papers must be no longer than

References (7)

There are more references available in the full text version of this article.

Cited by (20)

  • Effect of inhaling fragrances on relieving pricking pain

    2005, International Journal of Aromatherapy
  • Perineal care. Then and now

    1990, Journal of Nurse-Midwifery
  • Lasers in proctology

    2022, Lasers in Proctology
  • Diclofenac rectal suppository: An effective modality for perineal pain

    2016, Journal of the Pakistan Medical Association
View all citing articles on Scopus
View full text